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PMMC Healthcare Revenue Cycle Blog
Stay up to date on best practices for healthcare revenue cycle management with PMMC's blog.
Optimizing Payor Negotiations with Proven Strategies for Hospital CFOs
Healthcare organizations face a growing array of challenges—from fluctuating reimbursement rates and evolving payment models to the increasingly intricate landscape of payor contracts. The financial stakes have never been higher, requiring healthcare finance teams to shift from traditional negotiation methods to more strategic, data-driven approaches.
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Unlocking Value in Payor Negotiations
Negotiating with payors is one of the most complex responsibilities in healthcare finance. Healthcare systems grapple daily with intricate contracts, tightening margins, and the critical need to stay compliant with shifting healthcare regulations. These negotiations are essential for balancing revenue streams, reducing inefficiencies, and securing long-term financial sustainability.
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Strategic Pricing Drove Up To a 15 Percent Increase in Net Revenue
Effective pricing strategies are critical for driving profitability in healthcare organizations. Organizations that take a strategic approach to chargemaster adjustments often see significantly better results—reporting between a 2 to 15 percent increase in average net revenue year-over-year (YoY), compared to just 3 percent for those without such strategies. Here’s how these targeted adjustments lead to substantial growth and why they matter.
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Timely Filing Denials are on the Rise. Here's What You Need to Know
Timely filing denial rates are hitting revenue cycle teams harder than ever, with a staggering 267% increase YoY for timely filing denials on appeals. This surge is more than just an unsettling trend; it represents significant revenue loss and operational inefficiency. To protect your organization’s bottom line, addressing this issue requires both immediate action and strategic contract renegotiations.
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Business Insights | Contract Modeling
Leveraging Medicare Benchmarks in Contract Negotiations
When it comes to hospital reimbursement, one statistic often dominates the conversation—on average, hospital commercial reimbursement is coming in at approximately two to three times Medicare reimbursement. It’s critical to understand how your organization stacks up against industry benchmarks since this can significantly affect preparations for contract negotiations and your bottom line. Through analysis, we've found reimbursements to be approximately 200%-215% of Medicare. But here's the big question—how do you use this data strategically to enhance contract negotiations, improve financial planning and analysis (FP&A), and maximize net revenue?
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Why a Safety-Net Review could save you millions
Denials and underpayments are a constant challenge for hospitals, putting significant pressure on financial teams to recover lost revenue. With continual market shifts and inconsistencies in payor behavior, staying on top of these issues can feel like a moving target. That’s where having a safety-net review comes in—leveraging analytics, AI technologies, and decades of expertise to help hospital teams recover cash, minimize false variances, and optimize reimbursement processes.
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Keeping Accounts Receivable Under Control and Ensuring Financial Health
With a 21% increase in Accounts Receivable (AR) trends, is your team preparing for impacts on your organization's financial health? We're taking a closer look at aging Accounts Receivable (AR) – a vital indicator often influenced by external factors, like changes in payer behaviors and increasing denials.
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